tbuckley/cabot-search huggingface dataset:
Abstract 10108: SuPAR, Galectin-3 and ST2 Are Associated With Chronic Kidney Disease Progression in Patients With Heart Failure With Reduced Ejection Fraction
Authors: Jonathan S Gordon, Bethany Roehm, Pin Xu, Meredith McAdams, Justin L Grodin, Susan Hedayati
Journal: Circulation (2022)

Introduction: Patients with heart failure with reduced ejection fraction (HFrEF) are at risk for both acute and progressive kidney disease. Elevated levels of the circulating soluble urokinase plasminogen activator receptor (suPAR), Galectin-3, and soluble suppression of tumorigenicity 2 (ST2) have been associated with kidney disease progression in those with CKD. However, there is little known about their predictive value for glomerular filtration rate (GFR) decline in populations with HFrEF. Methods: We aimed to determine whether these biomarkers were associated with decline in GFR and death in patients with HFrEF. We included 310 participants from the Registry Evaluation of Vital Information for Ventricular Assist Devices in Ambulatory Life in whom baseline suPAR, Galectin-3, and ST2 and repeated measures of GFR were obtained. The primary outcome was change in 2021 CKD-EPI creatinine-based GFR over 2 years. Secondary outcome was mortality. A joint cox regression model for mortality controlled for age, sex, race, NYHA class, and change in GFR and accounted for competing risks of ventricular assist device (VAD) implantation and heart transplantation. Results: Participants were followed for 2 years or until VAD, transplant, or death. Mean age was 59 years (standard error of mean 0.7) and 36% had diabetes mellitus. Median GFR was 60 ml/min/1.73m 2 with 58% NYHA Class III. Of these, 45 died, 33 received LVAD, and 25 were transplanted. Higher baseline suPAR (β coefficient -0.22 √(ml/min/1.73m 2 ); 95%CI -0.29, -0.15; P&lt;0.001), Galectin-3 (β coefficient -0.02 √(ml/min/1.73m 2 ); 95%CI -0.04, -0.01; P=0.012), and ST2 (β coefficient -0.01 √(ml/min/1.73m 2 ); 95%CI -0.02, -0.01, -0.19; P&lt;0.001) plasma concentrations were associated with a decline in eGFR over time in multivariable models. Only ST2 (HR 1.02 per ng/mL increase; 95%CI 1.01, 1.03; P&lt;0.001) was associated with mortality, after controlling for longitudinal change in GFR. Conclusions: Higher baseline suPAR, Galectin-3, and ST2 were associated with GFR decline over 2 years in patients with HFrEF. ST2 was associated with a greater risk of mortality, while suPAR and Galectin-3 were not. These biomarkers may be incremental tools used to predict GFR decline in patients with advanced heart failure.
Abstract 10740: Effects of Renin-Angiotensin-Aldosterone-System Inhibitors on Coronary Atherosclerotic Plaques: Results From the Paradigm Registry
Authors: Curtis Williams, Donghee Han, Hidenobu Takagi, Christopher Fordyce, Stephanie Sellers, Philipp Blanke, Fay Y Lin, Mouaz H Al-Mallah, Matthew J Budoff, Prof. Dr. Filippo Cademartiri, Kavitha M Chinnaiyan, Edoardo Conte, Hugo Marques, Ilan Gottlieb, Martin Hadamitzky, Sanghoon Shin, Byoung Kwon Lee, Renu Virmani, Habib Samady, Jung Hyun Choi, Daniel Berman, Jagat Narula, Jeroen J Bax, Jonathon Leipsic, Hyuk-Jae Chang
Journal: Circulation (2022)

Introduction: Coronary CT Angiogram (CCTA) has become a powerful tool in the diagnosis and risk stratification of coronary artery disease (CAD), but can also provide unique insight into the effects of pharmacotherapy on the progression of atherosclerosis. Although Renin-Angiotensin-Aldosterone-System (RAAS) inhibitors are indicated in patients with stable CAD, their impact on the progression of coronary atherosclerosis is unclear. Methods: We performed a prospective, multinational study consisting of a registry of patients without history of CAD who underwent serial CCTAs at an interscan interval of &gt;2 years. Patients taking RAAS inhibitors were propensity matched to RAAS inhibitor naïve patients based on clinical and CCTA characteristics at the baseline. Atherosclerotic plaques in CCTAs were quantitatively analyzed for percent atheroma volume (PAV) according to plaque composition (necrotic core, fibro-fatty plaque, fibrous plaque, and calcium) using predefined Hounsfield unit thresholds. Results: Of 1,248 patients from the registry, 299 RAAS inhibitor taking patients were matched to 299 RAAS inhibitor naïve patients. Over a median interval of 3.9 years, there was no significant difference in annual progression of total PAV between RAAS inhibitor naive vs taking patients (0.75 vs 0.79 %/year, p = 0.66), nor was there any difference in the progression of necrotic core (-0.02 vs 0.002 %/year, p = 0.09), fibrofatty plaque (-0.03 vs.0.05 %/year, p = 0.67), fibrous plaque (0.29 vs 0.25 %/year, p =0.91), or calcified plaque (0.51 vs. 0.51 %/year, p = 0.37). Conclusions: Within this cohort of patients, the use of RAAS inhibitors over a period of nearly 4 years did not have a measurable impact on progression of total atherosclerotic plaque or any plaque subtypes assessed by CCTA. These results suggest that the benefit of RAAS inhibition is independent of an effect on coronary plaque progression.
Abstract 10126: Impact of Albuminuria on Prognosis After Transcatheter Aortic Valve Replacement for Aortic Stenosis
Authors: Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Yoshinori Shirai, Tatsuya Miyazaki, Satoshi Yuhara, Sho Akita, Kenji Furusawa, Hideki Ishii, Toyoaki Murohara
Journal: Circulation (2022)

Introduction: Albuminuria is a well-known risk factor of cardiovascular events. However, the impact of albuminuria on the prognosis in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) has not been studied. Methods: This is a single-center retrospective observational study. Consecutive patients who underwent TAVI for severe AS and whose preoperative urinary data were available were included. Finally, 228 patients were investigated. Patients were divided into two groups according to the preoperative urinary albumin-to-creatinine ratio (ACR): high (ACR≥ 30 mg/g) and low (ACR&lt;30 mg/g). Total protein to creatinine ratio (PCR) and dipstick proteinuria were also evaluated. The primary outcome was a composite endpoint of all-cause death and readmission due to heart failure. Results: There were 117 patients with a high ACR and 111 patients with a low ACR. At baseline, patients with a high ACR had significantly lower eGFR than those with a low ACR. During the median follow-up period of 467 days, the patients with a high ACR had higher incidence of a primary endpoint than those with a low ACR (p&lt;0.001). The individual incidence of all-cause death, cardiac death and heart failure readmission were also significantly higher in patients with a high ACR than those with a low ACR. Patients with PCR≥150mg/g or positive dipstick proteinuria were at a higher risk of primary endpoint as well (p&lt;0.001 and p=0.008, respectively), however, there was no significant difference between the patients with eGFR&lt;60 and ≥60 mL/min/1.73m 2 (Figure). Multivariate Cox proportional hazards analysis showed a high ACR was independently associated with a primary endpoint (HR, 4.98; 95% CI, 1.84-13.49; p=0.002). Conclusions: Preoperative albuminuria (ACR≥ 30 mg/g) is an independent predictor of cardiac events in the patients with severe AS undergoing TAVI. PCR≥150 mg/g and positive dipstick albuminuria are also useful for risk prediction.
Abstract 10064: Tracking Multi-Organ Treatment Response in Systemic Al-Amyloidosis With Cardiac Magnetic Resonance Derived Extracellular Volume Mapping
Authors: Adam Ioannou, Rishi Patel, Yousuf Razvi, Aldostefano Porcari, David Hutt, Ana Martinez-Naharro, Tushar Kotecha, Lucia Venneri, Liza Chacko, Daniel Knight, Helen Lachmann
Journal: Circulation (2022)

Introduction: Systemic light-chain (AL) amyloidosis commonly involves the liver, spleen and heart. Cardiac magnetic resonance (CMR) with extracellular volume (ECV) mapping has demonstrated accuracy in measuring hepatic, splenic and cardiac amyloid infiltration. We sought to assess multi-organ response to treatment using CMR derived ECV mapping. Methods: We identified 351 patients who underwent baseline SAP scintigraphy and CMR at diagnosis, of which 171 had follow-up imaging. Results: Liver and spleen ECV correlated with amyloid load assessed by SAP scintigraphy (R=0.751, P&lt;0.001; R=0.765, P&lt;0.001), with serial measurements accurately tracking treatment response. ECV regression was observed at 6-months in those with a good haematological response (liver=15%, spleen=15%, heart=5%). The remaining patients with a good response had stable liver and spleen ECVs, but 20% had cardiac progression. Baseline liver (HR=1.03, 95%CI[1.01-1.05], P&lt;0.001) and myocardial ECV (HR=1.05, 95CI%[1.03-1.07], P&lt;0.001) independently predict mortality. Change in liver (HR=1.06,95%CI[1.01-1.11], P=0.015) and myocardial ECV (HR=1.11, 95%CI[1.02-1.19], P=0.011) a 6-months independently predict mortality, while liver and cardiac regression at 12-months predict survival. Conclusions: Multi-organ ECV quantification accurately tracks treatment response, and demonstrates different rates of organ regression, with the liver and spleen regressing more rapidly than the heart. Liver and myocardial ECV at diagnosis and increases in ECV at 6-months independently predict mortality.
Abstract 10183: Structural Characteristics of Patients With Superior Vena Cava Foci Initiating Atrial Fibrillation: Analysis With Electrocardiogram-Triggered Computed Tomography
Authors: Satoshi Oka, Kenichiro Yamagata, Yuichiro Miyazaki, Akinori Wakamiya, Keiko Shimamoto, Nobuhiko Ueda, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, kohei ishibashi, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, Kengo Kusano
Journal: Circulation (2022)

Introduction: The superior vena cava is the most common source of non-pulmonary vein foci in atrial fibrillation. Hypothesis: Predicting the existence of non-pulmonary vein foci prior to the catheter ablation procedure is helpful because recent one-shot ablation technologies are designed to isolate only the pulmonary veins. We aimed to clarify the structural characteristics of patients with superior vena cava foci initiating atrial fibrillation. Methods: We enrolled 331 consecutive patients with atrial fibrillation who underwent computed tomography cardiac imaging before radiofrequency catheter ablation treatment. The patients were divided into superior vena cava (+) and (-) groups according to having superior vena cava foci or not. The characteristics of 27 patients per group, identified with propensity score matching, were compared. Results: The superior vena cava (+) group exhibited superior vena cava crescent signs, defined as a curve-shaped superior vena cava with two narrow pointed ends, more frequently (40.7% vs. 7.4%, p =0.004), and a right atrial volume larger than the superior vena cava (-) group (95.6 ± 20.8 vs. 83.5 ± 18.7 mL, p =0.030). Multivariate logistic regression analysis revealed that the superior vena cava crescent sign (odds ratio, 8.45; 95% confidence interval, 1.52-46.99) and right atrial volume ≥ 80 mL (odds ratio, 4.66; 95% confidence interval, 1.22-17.79) were independent predictors of superior vena cava foci. Conclusions: Patients with superior vena cava foci exhibited more frequent superior vena cava crescent signs and larger right atrial volumes. These characteristics may help clinicians choose the appropriate ablation technology.
Abstract 10105: Health Disparities in Cholesterol Screening Among Older Americans: Longitudinal Analysis of the Health and Retirement Study (2008-2018)
Authors: Wan-Chin Kuo, Serena L Sorensen, Heather M Johnson
Journal: Circulation (2022)

Introduction: Hypercholesterolemia is often asymptomatic and requires cholesterol screening to be identified. Current guidelines recommend adults at low risk for cardiovascular disease (CVD) to receive cholesterol screening at least every 5 years with more frequent screenings in older adults and/or at higher CVD risk. Yet, currently, about 25% of Americans do not meet the every-5-year screening recommendations. While disparities in the prevention and treatment of hypercholesterolemia continue to rise, little is known regarding factors influencing cholesterol screening among older Americans in the past 10 years. Methods: This longitudinal analysis used data from the Health and Retirement Study (HRS). HRS is a nationally representative survey of older adults in the U.S. The current study focused on data collected from 2008 (Wave 9) to 2018 (Wave 14). Participants who passed away by 2019, ever had CVD or stroke, were under age 55 at baseline, had more than 3 waves of missing data in self-reported cholesterol screening, or any missing data in covariates were excluded from the current analysis. In total, 7643 participants were included. Meeting cholesterol screening recommendations was defined as those reporting more than two cholesterol screenings between waves 9-14. Poisson regression and logistic regression were used for data analysis. Results: Compared to Black, Indigenous, and People of Color (BIPOC), White older Americans were more likely to meet cholesterol screening recommendations (odds ratio= 1.60; p&lt;0.001) and reported a higher frequency of cholesterol screening (incidence rate ratio=1.06; p&lt;0.001). The racial differences remained significant after the adjustment of covariates. Non-smokers (p&lt;0.001), females (p=0.022), having private insurance (p&lt;0.001), higher education (p&lt;0.001), higher BMI (p=0.003), having diabetes (p&lt;0.001), and having hypertension (p&lt;0.001) were associated with a higher likelihood of meeting cholesterol screening recommendations. Conclusions: Important disparities in cholesterol screening were identified among racial minorities, smokers, individuals without private insurance, or with lower educational attainment, highlighting important barriers to address in cardiovascular preventive care.
Abstract 10172: Q Neurons-Induced Hypometabolism Ameliorates Acute Kidney Injury Associated With Renal Ischemia in a Mouse Model Mimicking Cardiovascular Surgery Requiring Circulatory Arrest
Authors: Shoichi Kyo, Kozue Murata, Masahide Kawatou, Kenji Minatoya, Genshiro A Sunagawa, Hidetoshi Masumoto
Journal: Circulation (2022)

Introduction: Acute kidney injury (AKI) is a serious complication after cardiovascular surgery requiring circulatory arrest and hypothermia has been used for organ protection. We recently reported that mice can be induced into a hibernation-like hypometabolic state by the stimulation of a specific neuron producing pyroglutamylated RFamide peptide (QRFP) located at hypothalamus (Q neurons-induced hypometabolism; QIH). Here, we investigated the efficacy of QIH for the amelioration of AKI in an experimental circulatory arrest under normal and reduced body temperature using a transgenic mouse model in which QIH can be induced. Methods: We genetically prepared mice in which Q neurons specifically express iCre, a Cre recombinase (Qrfp iCre mice), from male C57/B6J mice. To prepare QIH-ready mice, we intracranially injected AAV8-hSyn-DIO-hM3-mCherry targeting hypothalamus for specific expression of hM3Dq in which QIH can be induced by intraperitoneal injection (i.p.) of clozapine-N-oxide (CNO), an agonist of hM3Dq. For the control, we injected AAV8-hSyn-DIO-mCherry. Mice were divided into 4 groups (n=6 for each): QIH-ready; normothermia (QN), QIH-ready; hypothermia (QH), control; normothermia (CN), and control; hypothermia (CH). At 3 hours after CNO i.p., left thoracotomy and 15-minutes descending aorta cross-clamping were conducted. After re-perfusion, we collected kidneys and evaluated histological changes and serum biochemical markers, neutrophil gelatinase-associated lipocalin (NGAL) and Cystatin C indicating early kidney injury. Results: Normothermia showed higher tubular injury scores than those in hypothermia (QN vs QH: p=0.0021, CN vs CH: p&lt;0.001). QN showed a lower tendency than CN (CN vs QN: 3.0±1.1 vs 2.5±0.55, p=0.51). QN exhibited lower NGAL and Cystatin C levels than those in CN (NGAL: CN vs QN:1.51±0.71 vs 0.82±0.32, p=0.0414 / Cystatin C: 1.48±0.39 vs 0.71±0.26, p=0.0015). There was no significant difference between QN and QH (NGAL: 0.82±0.32 vs 0.44±0.13, p=0.411 / Cystatin C: 0.71±0.26 vs 0.65±0.22, p=0.987). Conclusions: QIH partly ameliorated AKI in a mouse ischemia model even in normothermia. QIH might be a promising approach to achieving sufficient kidney protection without hypothermic circulatory arrest in the future.
Abstract 10045: Higher Renal Vascular Resistance is Associated With Greater Body Mass Index in Children
Authors: Kenji Harada, Yukiko Harada
Journal: Circulation (2022)

Background: Obesity is associated with increased risk for cardiovascular and renal diseases, however, there has been little focus on renal vascular function. The purpose of this study is to assess renal vascular flow regulation and investigate their relation to cardiovascular risk factors in obese children. Methods: Noninvasive ultrasonographic measurements were made in 108 overweight/obese children aged 7 to 13 years (body mass index 18 to 33kg/m 2 ). Using color Doppler sonography, peak systolic (PSV), end-diastolic (EDV), and average peak flow (APV) velocities of renal artery were measured. Pulsatility index as a parameter of vascular resistance was calculated. Pulsatility index was defined as (PSV-EDV)/APV. Quantitative B-mode ultrasound scans were used to measure intima-media thickness and diameters of the common carotid artery. Plasma lipid concentrations, uric acid, homeostasis model assessment of insulin resistance, and high sensitivity C-reactive protein were assessed in the obese children. Results: Compared with overweight children with body mass index &lt;25 kg/m 2 , pulsatility index in obese children with body mass index≥25 kg/m 2 was significantly higher (1.24 ±0.13 vs. 1.13 ±0.14 cm/sec, p &lt; 0.01), because APV and EDV were significantly lower (35 ±3 vs. 38 ±7 cm/sec and 21± 3 vs. 25 ±5 cm/sec, p &lt;0.05, respectively), although PSV was not significantly different. Pulsatility index correlated significantly with body mass index (r =0.58, p &lt; 0.01), insulin (r = 0.24, p &lt; 0.05), homeostasis model assessment of insulin resistance (r =0.25, p &lt; 0.01), triglycerides (r = 0.26, p &lt; 0.01), uric acid (r = 0.22, p &lt; 0.05), systolic blood pressure (r = 0.31, p &lt; 0.01), and carotid intima-media thickness (r = 0.36, p&lt;0.01). Renal blood flow velocities did not correlate with high sensitivity C-reactive protein. Conclusions: The present study indicates that obesity can adversely affect renal vascular flow and resistance in children. Obesity-related insulin resistance may be a main risk factor for renal vascular flow changes. Obesity not only is a risk factor for later cardiovascular disease, but also is associated with significant impairment of renal arterial flow dynamics.
Abstract 10049: Outcome of Telemedicine Compared With Traditional In-Person Follow-Up Visits in Patients With Acute Coronary Syndromes. Virtual Heart Study
Authors: Juan Sierra, Laura Rojo Grajales, Carlos Matute-Martinez, Rami Al-Ayyubi, Prince ernest, Alejandro Herrera-Ramos, Fernando Boccalandro
Journal: Circulation (2022)

Introduction: Telemedicine offers considerable opportunities to bring high-quality cardiovascular care. Its role in the ischemic-heart disease continuum in patients with acute coronary syndromes (ACS) has not been previously evaluated. Hypothesis: Virtual visits (VV) can be used as an alternative to in-person (IV) follow-up office visits in patients with ACS. Methods: 418 patients undergoing angiography for ACS (104 STEMI/314 NSTEMI) were randomized to follow-up via VV (n=208) using a free patient commercial platform or IV (n=210) between February and December 2020. Primary endpoints included major adverse cardiovascular events (MACE) at 1,6 and12 months and 1-year all-cause mortality. Secondary endpoints included 1-year adherence to guideline based-medical therapy including LDL-c &lt; 70 mg/dl, dual antiplatelet therapy, beta-blockers, ACE/ARB/ARNI, Aldosterone antagonists for patients with EF&lt;40%, participation in cardiac rehabilitation, cardiovascular-related hospitalization and all hospitalizations, and crossover between follow-up modalities. Follow-up was scheduled at 2,4,8,12 weeks after discharge and every 12 weeks afterward for one 1 year. Results: No significant difference was found in the demographics, procedural variables, baseline laboratories, ejection fraction, revascularization modalities, therapy at discharge, subjects lost-to-follow-up, missed, and rescheduled visits among study groups. MACE at 1-month [IV:1.9% Vs VV:1.4% (p =0.74)], 6-months [IV:6.7% Vs VV:5.8% (p =0.66)],12-months [IV:10.5% Vs VV: 10.6% (p =0.99)] and 1-year all-cause-mortality [IV:5.7% Vs VV: 6.7% (p =0.76)] was similar between groups. No significant difference was found between groups regarding all secondary endpoints including guideline-based medical therapy, participation in cardiac rehabilitation, CV-related death, and all hospitalization. The patients in the VV group had a higher incidence of crossover to IV visits at the end of the study [IV:5(2.4%)Vs VV:25(12%) (p &lt; 0.01)]. Conclusions: Telemedicine can be a valuable tool in the follow-up care in patients with ACS during the first year after index hospitalization, resulting in similar outcomes compared with traditional in-person follow-up visits.
Abstract 10638: The Effectiveness of Covid 19 Vaccines Against New Onset Atrial Fibrillation in Hospitalized Covid 19 Patients
Authors: Gustavo A Vargas, Jilla R Azarbal, Fei Tang, Iriana S Hammel
Journal: Circulation (2022)

Introduction: Cardiovascular complications are prevalent in COVID-19 individuals and have a poor prognosis. A link between atrial fibrillation (AF) and hospitalized COVID-19 patients was reported. Vaccines were shown to be highly effective against COVID-19 infection, poor outcomes and death. Methods: In this retrospective cohort study, we used US Veterans Health Administration COVID-19 Corporate Data Warehouse data to evaluate vaccine protection against new onset AF in patients hospitalized with COVID-19 infection. We included veterans without baseline AF who were hospitalized with COVID-19 between January 01, 2021, and November 10, 2021, and obtained their socio-demographic characteristics, diagnoses, vaccination information, symptoms, all-cause death, and diagnosis of AF during hospitalization. We define “fully vaccinated” at the time of infection as follows: for the BNT162b2 vaccine, at least 7 days from receipt of the second dose; for mRNA-1273 and Ad26.COV2.S, at least 14 days from receipt of the second dose and first dose, respectively. Partially vaccinated patients and patients hospitalized before testing positive were excluded. Considering competing risk from death, the Fine-Gray subdistribution hazard model was used to evaluate the effect of vaccination on new onset AF. Statistical analyses were performed using R (the R project for statistical computing, version 4.0.5). Results: We identified a total of 23,595 veterans hospitalized with COVID-19 positive infection without baseline AF. 1,807 (7.7%) patients were diagnosed with new onset AF before discharge from the hospital. Among vaccinated patients, 363 (6.0%) developed new onset AF, while among unvaccinated patients, 1,004 (5.7%) developed new onset AF. After adjusting for age, BMI, race, ethnicity, gender, diabetes, hypertension, COPD, CVD, and kidney disease, smoking status, alcohol abuse, substance abuse, vaccination was associated with 12% reduction in the risk of new onset AF (adjusted HR=0.88,95%CI:0.79-0.93). Conclusion: For hospitalized patients with COVID-19 infection, vaccination protects against new-onset AF. Further studies are needed to stratify hospitalized patients with COVID-19 at high risk of developing new onset AF.